NHS savings plan led to cuts in some 'ineffective' treatments

The drive to reduce NHS spending led to a drop in some treatments considered 'low-value', according to new research.

However, in the absence of clear national guidance about which procedures to perform less, the cuts were applied inconsistently by commissioning groups.

From April 2011, England's NHS was challenged to find £20 billion of efficiency savings over four years, in part by reducing the use of ineffective, overused or inappropriate procedures.

Researchers at Imperial College London found that the first year of savings coincided with a significant drop in three procedures considered potentially 'low value': removal of cataracts, hysterectomy for heavy menstrual bleeding, and myringotomy to relieve eardrum pressure. There was no significant change in three other 'low-value' procedures: spinal surgery for lower back pain, inguinal hernia repair, and primary hip replacement, or in two 'benchmark' procedures. (See notes to editors.)

The findings are reported in the March issue of the journal Health Affairs.

Sophie Coronini-Cronberg, from the School of Public Health at Imperial College London, who led the study, said: "During this period of austerity, each pound spent needs to be squeezed to deliver the maximum health value. The data suggest the NHS may indeed be managing costs in a rational way by reducing some procedures that have limited or low clinical value. However, we cannot be sure that it is those patients who would not benefit from surgery that are being excluded.

"Our research revealed a lack of consistency between commissioning organisations regarding which procedures were cut. With little national guidance about which procedures to remove or restrict funding for and under which circumstances, commissioners may be turning to locally developed, unofficial lists and criteria of low value treatments. This urgently needs to be addressed to avoid local variations. Arbitrary decision-making needs to be replaced with objective, consistent, evidence-based policies."

The Imperial researchers looked at hospital statistics for six procedures that appear on such lists to see which had been affected and whether cuts were applied consistently across primary care trusts in the first year of the savings programme.

Myringotomy, a procedure to relieve pressure in the ear which is considered relatively ineffective, declined by 11.4 per cent overall. The number of procedures fell in 25 per cent of trusts, but increased in six per cent.

Two procedures considered only effective in certain circumstances also fell overall. Hysterectomy for heavy menstrual bleeding declined by 10.7 per cent overall, but while 13 per cent of trusts recorded a fall, four per cent saw an increase. Cataract removal declined by 4.8 per cent, with procedures falling in 31 per cent of trusts and rising in 13 per cent.

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The study was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North West London.

2. The selected 'low-value' procedures are either relatively ineffective (spinal surgery for lower back pain; myringotomy to relieve eardrum pressure; and inguinal hernia repair, which is potentially cosmetic) or effective in certain circumstances (cataract removal; primary hip replacement, in which the risks of intervention may outweigh any potential benefits in mild cases; and hysterectomy for heavy menstrual bleeding, for which alternative options should be tried first).

The study also included two benchmark procedures: coronary revascularisation and cholecystectomy (gall bladder removal). These are high-volume procedures that have not been subject to restriction guidelines. No change was seen in the rates of these procedures.

3. About Imperial College London

Imperial College London is one of the world's leading universities. The College's 14,000 students and 7,500 staff are expanding the frontiers of knowledge in science, medicine, engineering and business, and translating their discoveries into benefits for society.

Founded in 1907, Imperial builds on a distinguished past - having pioneered penicillin, holography and fibre optics - to shape the future. Imperial researchers work across disciplines to improve global health, tackle climate change, develop sustainable energy technology and address security challenges. This blend of academic excellence and its real-world application feeds into Imperial's exceptional learning environment, where students participate in research to push the limits of their degrees.

Imperial nurtures a dynamic enterprise culture, where collaborations with industrial, healthcare and international partners are the norm. In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.

Imperial has nine London campuses, including Imperial West: a new 25 acre research and innovation centre in White City, west London. At Imperial West, researchers, businesses and higher education partners will co-locate to create value from ideas on a global scale.
http://www.imperial.ac.uk

4. About the National Institute for Health Research

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

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